Medical Mystery Monday #107: the case of the irregular periods

Happy Monday, everyone! Please, stay safe from Hurricane Sandy. Here’s another mystery for you to solve if you’re stuck indoors all day. This was another suggestion from a reader.

A 20 year old woman comes to her doctor because she missed her last two periods. She first started her menses at age 13, and they came every month for several years with regular duration and flow. Over the past year or so, her periods have become less frequent, about every two or three months. She is sexually active with her boyfriend (they use condoms for contraception), but she has had numerous negative home pregnancy tests over the past year. The patient has never been pregnant and has no other medical history to report.

On physical exam, the patient is noted to be overweight. Her vital signs are all normal. The physician notes the patient has acne and dark hair on her face (shown below). She also has increased hair on her arms. The rest of the physical exam, including a pelvic exam, is normal. When the doctor performs a transvaginal ultrasound, the ovaries are abnormal appearing (shown below).

What is the most likely diagnosis?

From emedicine.medscape.com.

Both of the patient's ovaries were abnormal appearing. From cincinnatifertility.com